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Successful aged and palliative care linkages in rural Victoria

End of life care at a rural aged care facility in Victoria is supported through education and consultancy support by the local and regional palliative care services.

Corangamarah Residential Aged Care is the home of up to 75 residents in Colac, two hours from Melbourne.  A service of the Colac Area Health Service it is also well placed to access expertise from within the broader service and provide continuity of care.

Corangamarah has also built its palliative care expertise through the state-wide Palliative Care in Aged Care Link Nurse Program funded by the Victorian Government since 2013. A Link Nurse based at the Barwon SW Regional Palliative Care Consortium provides valuable training and support in the palliative approach to care in aged care facilities across the region.

According to Daniel Tout, the Care Coordinator at Corangamarah, the Palliative Care In Aged Care Link Nurse Program is very successful.

“Myra McRae, the Link Nurse working with us, has a wealth of knowledge and her enthusiasm and passion for this sensitive and sometimes complex clinical practice has been paramount”.

Palliative Approach Toolkit

“The program uses the Palliative Approach Tool Kit promoted by the Commonwealth Government. It is very comprehensive and facilitates a consistent approach in providing a palliative approach to care and quality end of life care. The program demonstrates the importance of how to work collaboratively in a multidisciplinary environment. “

Daniel said “When we started the program it complemented education underway to upskill our enrolled nursing staff for their medication endorsement.

“They learnt how to be involved in the end of life care process, and that it was an inevitable part of their work and their residents’ time with us. It gave them confidence.”

Ali Weedon is the palliative care nurse for the Colac Area Health’s community nursing division. She works closely with Daniel and his team at Corangamarah. And actively supports the care of patients who would benefit from palliative care in the acute ward and receiving community care.

“All the staff are now more confident with the palliative approach, even though some still shy away from the reality of death,” she says.

Ali is able to provide the background to patients going into aged care from the hospital or from the home where she has been seeing them for symptom management, advance care planning and end of life care.

“Every patient’s journey is different, some go into hospital and are there for 30 days; others go into aged care and are only there for three days.”

Conversations about end of life care wishes

Part of Daniel’s role is to have a conversation with every new resident and family about advance care planning. It is best to discuss this earlier rather than leaving it to the time when end of life care is needed.

“It is very important to have a discussion with residents and families in an empathetic and meaningful way. Because of the training provided by the consortium, our nurses have the skills to communicate and respond to care with great professionalism.

Case Study

This gentleman had multiple morbidities including prostate metastases and renal failure. He was attending Colac Area Health’s hemodialysis unit and had been an acute patient. He was admitted to Corangamarah with a terminal diagnosis. Soon after his admission, his condition deteriorated as the dialysis was not working.

Daniel and the nursing staff discussed with the gentleman and his family his advanced care plan and end of life care. The resident wanted to be kept comfortable until the end and to not be in pain.  The family wanted to be advised of any changes in his condition, even if it was confronting. Together we agreed that pain management and communication were the goals of care.

A couple of weeks after his admission staff recognized that the pain management strategies were no longer effective. We held a case conference and agreed to implement the end of life pathway in accordance with the goals of care. Ali, our palliative care nurse, and the gentleman’s GP were called to provide the specialist services required at this time. Daniel spent time with the family and everybody agreed that the time had come to change the medication and to start saying goodbye.

The team, which included Daniel, Ali, the GP and other nursing staff also had a phone conference with a Palliative Registrar at Grace McKellar Centre in Geelong. In consultation with the family there was an agreement to cease using all therapeutic medication and focus on medication that would be more effective in relieving pain. This meant that the residents request to be pain free had been met.

“The family was kept informed throughout the process, and was grateful for the support and clarity that was given by the team,” said Daniel.

Ongoing, evidence-based palliative care

The Palliative Approach in Residential Care is a recurrent program as it is essential that staff are updated about an evidence based palliative approach to the care of residents.”

“I’ve got to make sure that if there’s an impending death the right staff with the right skills mix is available.”

The Palliative Care in Aged Care Link Nurse Program provides a service that educates the staff at Corangamarah and supports end of life decision making. Most importantly the residents are provided with care that is contemporary and collaborative.

Ali and Daniel both agree that the challenge is promoting the benefits of advanced care plans to the community.

“We both say: that to have some control of how you are cared for at the end stage of your life you need to make sure you have an advanced care plan.”

Ali continues to promote palliative care and is planning an educational lunch for local GPs during National Palliative Care Week, to update them on current end of life medication and treatment issues.

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